Summary
Definition
History and exam
Key diagnostic factors
- obesity
- male sex
- maxillomandibular anomalies
- excessive daytime sleepiness
- episodes of apnoea
- episodic gasping
- restless sleep
- insomnia
- macroglossia
- chronic snoring
Other diagnostic factors
- cardiovascular disease
- weight gain
- large neck circumference
- endocrine disorders
- history of difficult intubation for general anaesthesia; obstruction during sedation
- family history of OSA or snoring
- history of mucopolysaccharidoses
- history of GORD
- history of Down's syndrome
- history of tooth extractions for crowding
- history of motor vehicle accidents
- neurocognitive dysfunction
- mood disorders
- nocturia
- erectile dysfunction
- morning headaches
- heartburn/dyspepsia
- dry mouth
- nocturnal sweating
Risk factors
- obesity
- male sex
- post-menopause (women)
- large neck circumference
- maxillomandibular anomalies (e.g., narrowing, retrognathia, and high, arched palate)
- increased volume of soft tissues (includes tonsils, adenoids, and tongue)
- family history of OSA
- chronic snoring
- polycystic ovary syndrome (PCOS)
- hypothyroidism
- Down's syndrome
- mucopolysaccharidoses
- increasing age
- black, Hispanic, or Asian ethnicity
- tobacco smoking
- nasal obstruction
- levels of sex hormones
- alcohol use
- environmental tobacco smoke exposure
- opioid use
Diagnostic investigations
1st investigations to order
- attended polysomnography (PSG)
- unattended non-laboratory PSG
- portable multichannel home sleep tests
- awake fibreoptic endoscopy
Treatment algorithm
Contributors
Authors
Ofer Jacobowitz, MD, PhD, FAASM
Co-director of Sleep
ENT and Allergy Associates
Associate Professor
Department of Otolaryngology
Northwell/Zucker School of Medicine, Hofstra University
New York
NY
Disclosures
OJ is a scientific consultant for, and has received a consulting fee from Aerin Medical, LivaNova, Deerfield Catalyst, and Nyxoah. OJ has received research support from LivaNova for US Food and Drug Administration trial research. Aerin Medical has developed nasal valve treatment devices for nasal obstruction. Both LivaNova and Nyxoah have developed implantable neurostimulation systems for obstructive sleep apnoea. Zsquare has developed endoscopy systems. OJ is an author of a paper cited in this topic.
Peer reviewers
Carla Daltro, MD
Professor of Medicine
Bahiana School of Medicine and Public Health
Brazil
Disclosures
CD has been reimbursed by Sanofi-Aventis, Novartis, Merck Sharp Dohme, and Eli Lilly as an investigator of clinical trials.
Krishna M. Sundar, MD
Adjunct Assistant Professor
University of Utah
Director
Pulmonary & Critical Care Research
IHC Urban South Intermountain Utah Valley Pulmonary Clinic
Provo
UT
Disclosures
KMS declares that he has no competing interests.
References
Key articles
American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Full text
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Mar 15;13(3):479-504.Full text Abstract
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2019 Feb 15;15(2):335-43.Full text Abstract
Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 Jul 20;144(3):e56-67.Full text Abstract
Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015 Jul 15;11(7):773-827.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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